Yet an­other na­tion­wide fraud sweep

Lat­est take­down meant to spot­light Obama ef­forts

Modern Healthcare - - FRONT PAGE - Rich Daly

Asweep of 107 ar­rests for Medi­care fraud scams in seven cities marked the fourth time the Obama ad­min­is­tra­tion had cor­ralled an ar­ray of un­re­lated health­care cases for a na­tional an­nounce­ment.

The pur­pose of such take­downs, this one or­ches­trated May 2, is to demon­strate that fight­ing health­care fraud is a pri­or­ity for the ad­min­is­tra­tion and to de­ter more peo­ple from par­tic­i­pat­ing in such ac­tiv­ity, ac­cord­ing to cur­rent and for­mer fed­eral anti-fraud of­fi­cials.

“When Pres­i­dent Obama took of­fice, he asked the at­tor­ney gen­eral and me to make fraud preven­tion a Cab­i­net-level pri­or­ity,” HHS Sec­re­tary Kath­leen Se­be­lius said at a news con­fer­ence an­nounc­ing the lat­est busts.

Those march­ing or­ders led HHS and the U.S. Jus­tice Depart­ment to grow a com­bined Medi­care fraud-fight­ing team started in March 2007 in the south­ern dis­trict of Florida by the Bush ad­min­is­tra­tion to nine cities across the na­tion.

The strike forces have spear­headed an in­creased em­pha­sis on crim­i­nal pros­e­cu­tion of health­care fraud­sters, pro­duc­ing since their launch more than 1,330 ar­rests of peo­ple al­legedly in­volved in try­ing to bilk more than $4 bil­lion from the pro­gram. The pres­i­den­tial

or­ders also led to the use of high-pro­file group ar­rests of large num­bers of de­fen­dants, co­or­di­nated to oc­cur nearly si­mul­ta­ne­ously for max­i­mum pub­lic­ity.

The large co­or­di­nated ar­rests in dis­parate lo­ca­tions across the coun­try—last week’s was the sec­ond-largest num­ber of de­fen­dants to date and the largest dol­lar amount with $452 mil­lion in al­leged false claims—is a tac­tic bor­rowed from pre­vi­ous fed­eral ef­forts seek­ing to both en­cour­age and respond to public calls for ac­tion, such as the “war on drugs,” ac­cord­ing to for­mer fed­eral anti-fraud of­fi­cials.

The ap­proach gar­ners greater me­dia cov­er­age than in­di­vid­ual ar­rests and smaller dol­lar amounts, but it is not with­out risks. It in­evitably means some lo­cal law en­force­ment agents have to wait weeks or months to ar­rest a sus­pect if the ar­rest is re­quired to oc­cur with other cases where of­fi­cials are close but not yet ready to make an ar­rest, the for­mer of­fi­cials said.

Medi­care fraud sus­pects have fled in the past be­fore their ar­rests, said Gabriel Im­per­ato, a de­fense at­tor­ney for Broad and Cas­sel in Fort Laud­erdale and a for­mer deputy coun­sel for HHS in Dal­las. How­ever, sus­pects also have fled af­ter their ar­rest and re­lease on bond, he said.

The strat­egy also car­ries a risk for providers, ac­cord­ing to some for­mer fed­eral of­fi­cials, be­cause the busts may in­crease the like­li­hood that peo­ple with lit­tle ev­i­dence against them will be swept up in an ef­fort to boost over­all num­bers.

Even be­fore the ad­vent of large group ar­rests for health­care fraud, fed­eral anti-fraud of­fi­cials have ar­rested or searched the of­fices of health­care providers with­out ul­ti­mately bring­ing charges, said Jack Fer­nan­dez, a de­fense at­tor­ney for Washington-based Zuck- er­man Spaeder and a for­mer as­sis­tant U.S. at­tor­ney. But charges that are even­tu­ally dropped and even the ex­e­cu­tion of search war­rants with­out any later ar­rests can pro­fes­sion­ally de­stroy a physi­cian.

“If you think a physi­cian has done some­thing wrong, there are ways to find that in­for­ma­tion out with­out hav­ing to ar­rest that per­son,” Fer­nan­dez said.

The ad­min­is­tra­tion has been un­der pres­sure from some mem­bers of Congress to make more such ar­rests. For in­stance, Sen. Tom Coburn (R-okla.), who is a physi­cian, urged a panel of fed­eral anti-fraud of­fi­cials tes­ti­fy­ing be­fore the Se­nate Fi­nance Com­mit- tee on April 24 to ar­rest and ob­tain lengthy sen­tences for physi­cians as a de­ter­rent.

“If the doc­tors that are sign­ing false cer­ti­fi­ca­tions for home health aren’t go­ing to jail, you’re not send­ing the sig­nal for other doc­tors to change their be­hav­ior,” Coburn said. His call is fu­eled by a grow­ing be­lief that fraud on that scale per­pe­trated against Medi­care and Med­i­caid is only pos­si­ble with the in­volve­ment of many physi­cians, who are the gate­keep­ers, ac­cord­ing to one for­mer fed­eral pros­e­cu­tor.

As in pre­vi­ous group ar­rest an­nounce­ments, fed­eral of­fi­cials noted last week that the charges were lev­eled at physi­cians, as well as other types of health­care pro­fes­sion­als. Three physi­cians were specif­i­cally men­tioned, although nei­ther HHS nor Jus­tice of­fi­cials pro­vided a to­tal num­ber of them in­cluded in last week’s ar­rests.

The Medi­care strike force’s first pros­e­cu­tion of physi­cians in­volved a 2008 crack­down on costly HIV in­fu­sion ther­apy fraud in South Florida, which led the criminals be­hind the schemes to ad­mit to prose­cu­tors that they were hav­ing more dif­fi­culty re­cruit­ing new physi­cian part­ners, said Paul Pel­letier, a de­fense at­tor­ney at Mintz Levin and a for­mer prin­ci­pal deputy chief for lit­i­ga­tion at the Jus­tice Depart­ment. Medi­care billing for the ser­vice in three South Florida coun­ties dropped from 72% of all Medi­care pay­ments for such ser­vices in 2006 to a de­mo­graph­i­cally pro­por­tion­ate amount af­ter the crack­down, ac­cord­ing to HHS’ in­spec­tor gen­eral’s of­fice.

“We weren’t in­dict­ing ev­ery sin­gle in­fu­sion ther­apy provider, but we were do­ing a co­or­di­nated take­down so that they knew that we were on to them,” Pel­letier said.

AP PHOTO

HHS and U.S. Jus­tice Depart­ment of­fi­cials an­nounce 107 fraud-re­lated ar­rests dur­ing a news con­fer­ence May 2.

AP PHOTO

An agent loads seized boxes May 2 from a health agency in Mi­ami.

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